Provider Demographics
NPI:1487895264
Name:CHESNUT, CHRISTINA LYNNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LYNNE
Last Name:CHESNUT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3061
Mailing Address - Country:US
Mailing Address - Phone:502-523-3843
Mailing Address - Fax:
Practice Address - Street 1:9810 BLUEGRASS PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1906
Practice Address - Country:US
Practice Address - Phone:502-584-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist